The inspection was led by one inspector. Information we gathered during the inspection helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? During this inspection we looked at how well people were cared for, how the service managed cleanliness and infection control. Medication procedures were viewed in order to ensure they were safe and effective. We looked at the homes environment to see if it met the needs of people living at The Balmoral Rest Home. Also, how the home was staffed to meet the needs of people living there. We also looked at what quality monitoring systems were in place.
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, staff supporting them, and from looking at records. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Balmoral Rest Home.
If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
People told us that they felt safe. We were told staff were kind and caring. People also told us they felt respected by the people who supported them and their dignity was protected. Comments included, 'The staff are so kind and caring, couldn't ask for more'. Also, 'The girls have a lot of patience and they always have time for a chat'.
The home did not have policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The manager told us this was an area which needed to be developed and intended to attend training so that they would have the knowledge and skills to understand when an application should be made and how to submit one.
We saw the home had guidance in place for the management of infection control procedures, to ensure people were protected from the risks of poor hygiene practices. Protective clothing and gloves were made available to staff as well as a designated clinical waste management system. Staff we spoke with and observations we made confirmed they understood the principles of good hygiene practice. Most staff had attended Infection control training recently. We did find two toilets in the home did not have hand wash basin facilities in place. This meant that people were not provided with hand hygiene facilities in these areas. The manager was made aware of this and agreed the facilities required hand wash basins.
Medication practices had been reviewed recently to ensure the storage and administration was safe. We observed the morning administration of drugs. The manager and senior staff were responsible for the administration of drugs. Records we looked at showed they were accurate and up to date. We looked at the management of medication management for two people. The records we looked at and the level of stock was accurate in both instances. This meant the service managed medication safely.
Maintenance service certificates were in place and up to date to ensure systems in the home were safe. However, in one room we found access to the en suite facility was unsafe. In that there was a small step into the area. The resident using the room had fallen on one occasion due to tripping over the step. The door for this area did not close therefore the area remained a risk to the person using this facility.
Accidents and incidents were being recorded in daily log diaries for the individual resident. This meant it was difficult to identify any pattern occurring for people who may be at risk of falls.
Peoples weights were not being recorded as some people were unable to use the weighing facility available. In other instances peoples weight was not being recorded regularly therefore having the potential of putting them at risk due to being unable to monitor their weight effectively which can be an early indicator of ill health.
Is the service effective?
We were told that each person's health and care needs had been assessed prior to the service commencing. This was to make sure that the home could provide the level of care and support required. Records were available to support this. However in some of the records we looked at there was limited evidence of regular reviews taking place. This meant the management of peoples care planning may not be effective and up to date.
People's assessed needs were included in their care records. However, the records we looked at were disorganised so that it was difficult to follow any pattern of care. This included historic information being distributed throughout the file. A recent review had been placed in the centre of the file. This meant staff would have difficulty knowing what the current needs of the resident were.
Is the service caring?
People were seen to be supported by attentive and respectful staff. We saw that care workers showed patience and gave encouragement when supporting people.
Staff we spoke with told us it was a role they were proud to work in. 'I have done this work for some time now and really enjoy it' Another told us, 'I came here as a cleaner but now I work as a carer, it's really rewarding'.
People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes. Personal profiles had been developed by staff. Staff we spoke with told us this had helped them to understand things that were important with individual residents.
Is the service Responsive?
By not recording incidents that had occurred on individual records meant that it was not possible to confirm they had been reviewed and responsive action taken. Also although some of the detail of incidents were recorded, the outcome was missing from the records. We were told by the registered manager that outcomes would have been verbally discussed and action taken as required. However because of incomplete record keeping, we could not confirm this.
The service had a range of activities in place to support people to undertake chosen interests, There was evidence of organised parties and events throughout the year which people told us they enjoyed. A resident we spoke with said, 'There are things going on if you want to join in but it's up to you whether or not you choose to'.
People using the home and their relatives or advocates had completed six monthly satisfaction surveys. The results were used to inform the development and quality of the service. Any issues highlighted were looked at and responded to in order to ensure the home was responding to the needs of people.
Is the service Well Led?
The service had some quality assurance systems in place, however records seen by us showed not all the necessary documentation was completed, or that record keeping was robust and routinely applied. There was limited evidence of audits taking place for medication and care planning records. This meant there was a potential for constraints in the development of the service.
People we spoke with told us they felt supported by the manager and that they felt comfortable sharing any issues or concerns with them They felt confident they would be listened to and action taken where necessary.